Effects of Motor Imagery Technique With and Without Virtual Reality on Pain Intensity ,Functional Disability and Quality of Life in Patient With Post Stroke Shoulder Hand Syndrome (VR-SHS)

the current study is a randomized controlled trial comparing the effectiveness of motor imagery techanique with and without virtual reality on pain intensity , functional disability and quality of life for individual with post stroke shoulder hand syndrome . this trial aims to evaluate pain , functional disability and overall quality of life . the primary outcome is pain reduction . while seconday outcome reduce disability and improve quality of life .the hypothesis is that the combination of motor imagery and virtual reality will result in significant greater clinical improvement compared to motor imagery alone .

Study Overview

• Status: Completed
• Conditions: Complex Regional Pain Syndrome (CRPS); Shoulder Hand Syndrome
• Intervention / Treatment: Other: motor imagery with virtual reality; Other: motor imagery alone

Detailed Description

Stroke continues to be one of the most common neurological causes of long term disability across the world. It often leads to a wide range of sensory, motor, and cognitive impairments that significantly reduce independence and quality of life. Among the various secondary complications that follow a stroke, Shoulder Hand Syndrome is considered one of the most painful and disabling conditions. It is described as a condition that presents with severe shoulder pain, hand edema, joint stiffness, reduced range of motion, and progressive functional decline. The condition is also known as Complex Regional Pain Syndrome Type One after stroke and it commonly develops within the first few months of the neurological injury. Estimates suggest that the condition affects between twelve to thirty percent of stroke survivors and is associated with marked disability if not treated in a timely and effective manner.Traditional physical therapy approaches such as range of motion exercises, manual therapy, strengthening, and functional task training remain the foundation of treatment. However, these interventions are often limited when patients experience severe pain or fear of movement, which prevents active participation. This has created a need for interventions that can stimulate the brain and support motor recovery without requiring significant physical effort or causing pain. One such approach is motor imagery. Motor imagery is described as the mental rehearsal of movement without any actual execution of the movement. During motor imagery practice, the individual imagines performing a movement as vividly as possible while staying in a relaxed state.hile traditional motor imagery has been widely studied, the use of virtual reality as an adjunct tool has expanded rapidly in recent years. Virtual reality based rehabilitation offers an immersive and engaging environment where the patient experiences visual and sensory feedback that closely resembles real movement. The use of virtual reality enhances motivation, increases concentration, and improves patient satisfaction during therapy sessions. Most importantly, virtual reality supports the activation of mirror neuron pathways and enhances sensory motor integration, which are critical components of recovery after a stroke.The intervention for both groups was delivered over a structured six week period. Each participant attended therapy three days per week, and every session last for a total of thirty minutes. This schedule is designed to provide consistent therapeutic exposure while preventing fatigue and allowing adequate recovery between sessions. By maintaining the same duration and frequency for both groups, the study ensured that any differences in outcomes can be attributed to the type of motor imagery intervention rather than differences in treatment time.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • Green International Univeristy

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Post-stroke patients diagnosed with Shoulder-Hand Syndrome
• Age 40-70 years
• Both males and females
• Ability to understand motor imagery tasks
• Duration of stroke ≥ 3 months

Exclusion Criteria:

• Cognitive impairment
• Severe visual deficits
• Psychiatric illness
• Pain medication changes during study
• Uncontrolled medical conditions

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Motor imagery with virtual reality; participants of shoulder hand syndrome received a combination treatment of motor imagery with virtual reality .both treatment options provided to improve motor function , reduce pain and improve quality of life . provide treatment of both motor imagery and virtual reality	Other: motor imagery with virtual reality; participants will receive 30 minute intervention session .the integrated components consist of motor imagery and virtual reality followed by the application of affected arease
Active Comparator: motor imagery alone; participant in this arm will receive only motor imagery treatment protocol . the therapy will target shoulder and hand region to increse ROM , decrease stiffness and pain .	Other: motor imagery alone; participant will receive same 30 minutes session of specializes motor imagery techniques . no virtual reality sessions are included

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
PAIN INTENSITY	numeric pain rating scale is used to measure pain by rating one to ten according to the severity of the pain . scale level from 0 to 10 o means no pain 10 means higher level of pain	three session per week for sic weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
disability	shoulder pain and disability index (SPADI) use to measure level of disability at baseline and after intervention. the scale have scoring from 0 to 100 . 0 to 20 means mild shoulder pain and disability 21 to 40 means moderate shoulder pain and disability 41 to 60 means severe shoulder pain and disability 61 to 80 means very severe shoulder pain and disability 81 to 100 means extremely severe shoulder pain and disability	three times a week for six week

Collaborators and Investigators

• Sponsor: Green International University

Study record dates

Study Major Dates

• Study Start (Actual): November 2, 2025
• Primary Completion (Actual): April 29, 2026
• Study Completion (Actual): May 6, 2026

Study Registration Dates

• First Submitted: May 15, 2026
• First Submitted That Met QC Criteria: May 22, 2026
• First Posted (Actual): May 28, 2026

Study Record Updates

• Last Update Posted (Actual): May 28, 2026
• Last Update Submitted That Met QC Criteria: May 22, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: physiotherapy; virtual reality; motor imagery; shoulder hand syndrome; post stroke
• Additional Relevant MeSH Terms: Nervous System Diseases; Neuromuscular Diseases; Peripheral Nervous System Diseases; Autonomic Nervous System Diseases; Complex Regional Pain Syndromes; Reflex Sympathetic Dystrophy
• Other Study ID Numbers: GIU/REC/26-33

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: only ipd used in the results publication will be shared
• IPD Sharing Time Frame: it will be available after the completion of study
• IPD Sharing Access Criteria: through the corresponding author
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No